Positive predictive value of medical student specialty choices

Abstract

BackgroundAlthough medical school programs oriented toward postgraduate specialty training have the potential to reduce the duration and cost of medical school for US medical students, success depends on the ability of students to predict their postgraduate specialties. It is clear that first-year choices are poorly predictive, but it is not known when predictions become sufficiently reliable to support specialty-oriented learning programs. We therefore examined the predictive value of specialty preferences expressed at the ends of the first, second and third years of medical school and asked whether concurrent expressions of confidence in choices improved predictive ability. We also investigated the possibility that discrepancies between predicted and actual postgraduate specialty training were related to scores on an examination of knowledge in basic biomedical sciences required for US medical school graduation (the United States Medical Licensing Examination (USLME) Step 1 examination).MethodWe calculated positive and negative predictive values (PPV and NPV, respectively) for specialty choices and the sensitivity and specificity of asking for choices for 634 University of Colorado School of Medicine students who trained in 23 accredited residencies from 2011 through 2015. We examined the effect of confidence in first choices in 609 students, and in 334 students, sought an association between USMLE Step 1 scores and switching from postgraduate training specialties predicted at the end of year 2.ResultsThe PPV of first choices improved from years 1 through 3. NPV was high throughout. PPVs of year 3 first choices ranged from 79% in Anesthesiology to 95% in Psychiatry. Expressions of confidence in first choices did not improve PPV. Sensitivity of asking for first choices increased with time; specificity was consistently high. USLME Step 1 scores were higher for students who ultimately trained in specialties more competitive than first-choice specialties at the end of year 2.ConclusionsSpecialty-oriented learning programs during medical school must accommodate students who change career plans. The PPV of specialty first choices improves each year, but even year 3 predictions can be inaccurate with potential loss of students from specialty-specific programs. USMLE Step 1 scores appeared to affect career plans expressed at the end of year 2.Electronic supplementary materialThe online version of this article (10.1186/s12909-018-1138-x) contains supplementary material, which is available to authorized users.

Effect of the COVID-19 pandemic on medical student career perceptions: a national survey study

“…Jones et al found that, as one might expect, the positive predictive value of a medical student's top specialty choice increases from end of first year (ranging from 17% to 60% depending on specialty) through end of third year (ranging from 79% to 95%), suggesting that more exposure to fields of potential interest throughout medical school may result in increased accuracy of selfpredictions. They also found that students' self-reported level of certainty was not correlated with the positive predictive value of their specialty choice [34]. On the other hand, Manuel found that there was a significant relationship between first-semester medical students' predictions of whether they would apply into a technique-oriented or person-oriented specialty and their eventual choice [35].…”

Medical student residency preferences and motivational factors: a longitudinal, single-institution perspective

“…It has previously been reported, albeit in separate studies, that students pursuing primary care are more motivated by medical lifestyle/work-life balance (23,27,30), ease of residency entry (23), and family status (24). In contrast, students pursuing surgery or other non-primary care fields were more motivated by economics (23,24,28,29), prestige (22,24), and having more competitive application characteristics (23,57). Our study adds to these previous findings by comprehensively assessing the relative influence of many of these factors, not only on the basis of specialty choice, but also, uniquely, in association with different training stages.…”

Medical student residency preferences and motivational factors: a longitudinal, single-institution perspective

“…It has previously been reported, albeit in separate studies, that students pursuing primary care are more motivated by medical lifestyle/work-life balance [ 23 , 29 , 32 ], ease of residency entry [ 23 ], and family status [ 24 ]. In contrast, students pursuing surgery or other non-primary care fields were more motivated by economics [ 23 , 24 , 30 , 31 ], prestige [ 22 , 24 ], and having more competitive application characteristics [ 23 , 57 ]. Our study adds to these previous findings by comprehensively assessing the relative influence of many of these factors, not only on the basis of specialty choice, but also, uniquely, in association with different training stages.…”